Abstract: 222: Alendronate Treatment of Pediatric Patients with Connective Tissues Disorders. A Ten Year Follow-Up Study
Sangeeta Sule, M.D.
Authors:
R. Cimaz, M. Biggioggero, A. Boncompagni, F. Corona, L. Lepore, F. Zulian, F. Nacci, M. Beltramelli, F. Falcini, M. L. Bianchi.
Background:
In a study 10 years ago, the investigators showed that oral alendronate (ALN) was effective for children with connective tissue diseases to improve bone mineral density (BMD). The purpose of this abstract was to report safety and follow-up BMD data 10 years after the initial report.
Methods:
43/45 patients enrolled in the initial study 10 years ago were included in this analysis. 24 patients continued ALN for 8 months to 6 years, and 11 are still receiving treatment.
Results:
12 patients with SLE, 9 with polyarticular JIA, 8 with systemic JIA, 7 with dermatomyositis, and 7 with other connective tissue diseases were followed longitudinally. 3 of these patients were lost to follow-up after 5-8 years. Of the 43 patients, 24 continued ALN for 7 months to 6 years, 11 are still receiving ALN, and 10 stopped ALN after the initial study 10 years prior. All patients were treated with glucocorticoids for a mean duration of 10.5 ± 6.1 years. No significant side effects related to ALN were observed in this cohort. There was no observed impact on development or growth. In this cohort, 4 fractures occurred: 1 spine fracture after 15 months of ALN and 3 other fractures after ALN withdrawal. At the last DXA scan in the 24 patients who continued ALN, the BMD Z-score was -1.2 ± 1.3, change of +3.1 ± 0.9 from the initial study. In those who stopped ALN after the initial study, the Z-score was -0.9 ± 1.1, with a change of +0.7 ± 0.8.
Conclusions:
In this longitudinal study, ALN seems to be safe and well-tolerated in children with connective tissue disease. Continued use of ALN may improve BMD scores.
Editorial Comment:
There have been numerous concerns about the long-term use of bisphosphonates in children. In this abstract, investigators report follow-up of 43/45 patients initially enrolled 10 years ago in a study of alendronate. Though the numbers are small, alendronate was not associated with any significant toxicity and no long-term complications of growth and development were noted. This is important data for clinicians and parents considering treatment options for low bone mineral density. Larger studies powered to detect long-term complications would be important to study this further.
